2 questions

We should be starting Lantus again tomorrow. Not sure what dose yet. Didn't hear from the vet today. I emailed her a link to Maverick's spreadsheet.

1. I read this in the stickies in the health section. "Most people here would agree that feeding a cat between the time insulin peaks and the next shot is unwise, although a small high-protein, zero-carbohydrate snack such as chicken or tuna should not substantially affect blood glucose." With Lantus does this apply? Maverick is a wet food grazer - eating 2 to 3oz over 12 hours and often more at night. I fed him a brand new wet food today and he ate all 3oz in one sitting which is extremely rare and he will decide he doesnt' like it soon enough.

2. How soon after eating does bg peak normally. We are doing a non insulin blood glucose curve today. He ate much much more than normal in one sitting three hours ago. I tested at 1.5 hours expecting a big spike but there really wasn't one. Did I test too late?

Thanks.

Hi welcome to LL. any of us "front load" the cycle w/ several small meals early on. It helps to slow rapid drops when the insulin kicks in and thus avoid big bounces when the liver "panics" from sensing a much lower glucose level than it is used to. One thing we definitely do is remove food 2 hours before the preshot test so there will be no direct food influence.

ECID (every cat is different) some have early nadirs some very late. The only guarantee is that once you figure your cat out, he will change! We are talking about cats after all. That is why we are heavy on the testing here. The more we know about how they react, the better chance we have of making the right decisions.

This will at least bump you up the lis for more attention.

In a perfect world, the Lantus peak would be at +6 (6 hours after you gave a shot). However, the peak, or nadir, is a moving target. It could be at +6 one day, +4 another, and +7 the next cycle. Generally, you don't want to feed a substantial amount of food late in the cycle when the action of the insulin is on the decline. That said, many of us feed a small snack (about a teaspoon or so) of food around +8. As the pancreas, hopefully, starts to work again, a little bit of food may help to stimulate the pancreas to produce its own insulin and bring pre-shot numbers a little lower.

At least with LC food, you'll likely see a food spike an hour after eating.

Not sure if you saw this. Its the dosing protcol for Lantus from one of the sticky's, which you could discuss with your vet.

http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf

The wrecking crew eats a LOT more at night, but I load it towards the front of Shadow's cycle. small supper, then mini meals at +1, +2, +3. Shadow nadirs early, +3-4, so I want her to have some food in her tummy so the insulin doesn't make her go too low when it kicks in. So I don't really understand a curve without insulin. I can't see what kind of helpful information that might give you. Once Maverick has started his insulin, that kind of data is gold. But whatever you could learn on a curve without insulin is likely to change once he starts his meds. I don't want to contradict what your vet might be telling you, however. I hope he isn't charging you for this as it will likely not be very helpful.

klkelly said:

1. I read this in the stickies in the health section. "Most people here would agree that feeding a cat between the time insulin peaks and the next shot is unwise, although a small high-protein, zero-carbohydrate snack such as chicken or tuna should not substantially affect blood glucose." With Lantus does this apply? Maverick is a wet food grazer - eating 2 to 3oz over 12 hours and often more at night. I fed him a brand new wet food today and he ate all 3oz in one sitting which is extremely rare and he will decide he doesnt' like it soon enough.

Click to expand...

i believe not feeding between when the insulin peaks and the next shot does apply to lantus. until kitty starts showing signs of the pancreas doing it's job (usually seen on lower doses), feeding after peak can virtually put the brakes on the action of the insulin.

2. How soon after eating does bg peak normally. We are doing a non insulin blood glucose curve today. He ate much much more than normal in one sitting three hours ago. I tested at 1.5 hours expecting a big spike but there really wasn't one. Did I test too late?

Click to expand...

with most kitties, you'd expect to see a food spike within an hour after eating a meal. however, not all kitties spike after eating. ECID.

:::I fed him a brand new wet food today and he ate all 3oz in one sitting which is extremely rare

Maverick's bg is quite high and he's not regulated yet so I think he must be eating a lot coz of the uncontrolled diabetes. Is he drinking a lot too?

Thanks guys. Maverick's appetite has spiked with the diabetes - this is one of my concerns to speak with the vet about. He normally ate 5oz over a 24 hour period. He is peeing a fair amount but not flooding the litterbox. Just more than normal.

I will be so happy when he is regulated. I have the links for the university of queensland protocol and will be sharing with my vet for sure. I think she's still a bit annoyed with me for not following instructions though. Have to wait for the right time.

Thanks for all the info. I'm about to call in his BG numbers and today better be the day. I don't want to wait another day or be starting insulin at 10AM every morning/night.

I'm really getting frustrated and discouraged. I get a lecture about not listening to her about the insulin *reduced from 2 units to one the day we started insulin last week without her approval*. I'm told to stop all weekend, take his bg reading all day monday and call in with his bg readings on Tuesday so we can start insulin today. So I call in with his readings only to find out she isn't even in until 1:00PM and doesn't start morning shifts until Thursday. So I can't start him on insulin today. I'm really p*ssed off. I feel like it was a runaround. I voiced my displeasure with the tech. How the heck am I supposed to listen to her if she isn't available? MY only instructions last week were when in doubt call her and don't give a shot. Maverick seems to be doing well but I'm sitting here tearing up out of frustration. I want a partner in his care and really liked how she handled Maverick but I really don't like how she is handling ME.

I will be relieved when we start back on the lantus and get things working for him.

I do know we are ahead of the game with a vet up to home testing and one that recommended Lantus right off the bat. One day won't kill us but I'm really frustrated.

Hi Karrie...I was wondering were your numbers from Friday were on your SS.
You have done the right things in this Karrie. I understand your frustration with not being able to speak with her this morning. The way I see, you have lost the entire weekend from when you spoke with her last. She told you to stop the insulin over those two days and Monday too.
I hope things go well when you are able to finally talk to her.
Keep in mind though, that YOU are paying HER and that she works for YOU.

I realize that you wanted as vet who would be available for you whenever you needed her and wanted someone to guide you through this. The reality is that you have your meter and you can test so your need for her guidance will diminish as times goes by. You may find that you do not need her for dosing instructions any longer once you begin. Many of us are going it alone with the suggestions from this forum and the Protocol that we use....so we are not really "alone" but we are not under our vet's dosing instructions. It can be done while maintaining a relationship with the vet for other issues.

You might start a dose tonight too so today isn't totally lost. Keep testing him and see what she says. We are here if you want to share what her plan is. Do you have any other questions from the stickies that you read over the weekend?
What can we do to help? I understand your frustration, I think we all do. You are doing a great job! Maverick is a lucky kitty to have you! :mrgreen:

I have the numbers from last week on another spreadsheet. I had to put it in Canadian numbers and I can't for the life of me find a spreadsheet where both the Canadian and US numbers actually reflect the other measuring system. https://spreadsheets.google.com/pub...OVlDQ3BBSUc2aTBBcWFpZTBJcWc&hl=en&output=html

Thanks for the dose of perspective. I am going to get to the point where I'm confident doing this independently. I did forget that part in my mini pity party moment this morning.
If she doesn't go with the 2.0 units again I would have the confidence to start him tonight. I also hadn't thought of that.

My questions have really all been answered by the university of queensland protocol. Rereading that I understand how we will know when to lower dosing, when he can possibly be off the insulin if he does go into remission. I know once he is on the insulin his appetite will probably drop a pile. So I don't know how often we will need to test to ensure that things stay stable. I suspect that if the vet starts him at 1.0, and his appetite normalizes, he may not need a dose increase.

I was so frustrated and discouraged this morning. Thank you for replying. I'm nervous about speaking to her. I feel much better now though than I did this morning.

(((Karrie))) I'm sorry that you are having issues with the vet and with the SS. It's rough in the beginning, but things will improve. I nearly had a nervous breakdown in my early days, trying to get a SS and signature going. Once things calm down, you cam try taking another look at the world SS. I never used it (you can see in my SS that I had two rows per day, which makes the sheet look a bit busy), but I know others love it. Did you see this tutorial?

https://docs.google.com/present/view?id ... 27ftzbf3gr

Another idea would be to post a thread in tech support asking for help, or you could put "World SS help needed" in your condo here. Once things get sorted out with your vet you may feel more up to it.

I like your spreadsheet - the way you've done it. I think I will do that also. Since my vet got a bit annoyed that I wasn't using world numbers I just converted to the stand alone world spreadsheet to avoid confusing her and giving her any reason not to trust me. I think I will leave it in world numbers and add a second line for US numbers. Thank you so much for the suggestion.

I wish I could have someone be a go between, between me and vets. Some people just naturally get along with them some how. As I told someone else today, going to put on my big girl panties and do my best. I will get more confidence. I won't fail Maverick. I would find him yet another vet until I find the right one. I am still going to give this one the benefit of the doubt for Maverick's sake. She was actually able to handle him twice with me in the room. No bringing him back to the back for backup. So I liked that about her. She is good with him.

Don't give up on her if she is otherwise a good vet. I am sure that it is uncomfortable for a vet to have a client making their own decisions, or worse yet, getting advice on the internet, with dosing a potentially dangerous medication like insulin. I hope that the two of you can agree on a compromise.

I have asked some other Canadians to pop in if they get a chance and give you some SS help, if you still want to try the world format.

The vet just called and I feel 1000xs better. She is good with Maverick, really good. But I have an anxious personality and seem to make everything complicated

We are starting on 1 unit tonight. She gave me some reassurance that she has a diabetic cat on lantus also and did home testing for him.

I think having the instructions to go with 1 unit my anxiety has almost melted away.

Perfect!

FWIW: When I asked the people at the Lntus website about food and dosing they said that one had no relationship to the other with Lantus. Yes, they knew I was talking about a cat.

klkelly said:

We are starting on 1 unit tonight. She gave me some reassurance that she has a diabetic cat on lantus also and did home testing for him.

Click to expand...

Great! I think this is a much better place for Maverick to start.

She has a sugar kitty, too? Will be interesting to see what she can learn working with you. The partnership can go both ways. Seriously, I'm glad she called and you feel better about things now.

Karrie

Great news and I'm so glad you are feeling better now. I have a wonderful vet who understands that the FDMB is there for me 24/7...and she cannot be and also that the FDMB knows MUCH more about the protocol than she does. But when we had our initial conversation, I explained that Mike and I are Gracie's advocates..we know Gracie better than anyone, and we will do what we have to do to ensure her health. My vet agreed and said that with alot of vets, it's about their ego and not about the kitty....but it HAS to be about the kitty. I'm glad she's coming around; I would suggest that if you have any more issues with her, then make a list of questions regarding administering lantus, home testing, dosecreases, etc. and ask her in a very non-defensive way and see how much she can answer and discuss with you. Or invite her to register for the FDMB where she can read the info...my vet has done this and is amazed at the wealth of info and knowledge. I've also allowed my vet access to Gracie's SS and we discuss it from time to time.

This will be a great starting dose for Mimi and the advisors here will help you when it looks like he is ready for a dose adjustment. Just keep posting daily and keep his SS up to they can give you their best advice!! We're so excited you are starting his treatment. Hopefully, as soon as you get some insulin in him, you'll see him get back to his normal appetite, etc.

klkelly said:

I have the numbers from last week on another spreadsheet. I had to put it in Canadian numbers and I can't for the life of me find a spreadsheet where both the Canadian and US numbers actually reflect the other measuring system. https://spreadsheets.google.com/pub...OVlDQ3BBSUc2aTBBcWFpZTBJcWc&hl=en&output=html

Click to expand...

I have discovered that the link to the World-US SS does not work, and that the SS is no longer on Google Docs. I apologize for any inconvenience caused by recommending that you use that SS. ohmygod_smile

Hi Karrie and welcome to FDMB.
You are in a great place to help Maverick.

I tried getting to you earlier when someone mentioned that you were having problems
with your World SS but I had internet problems.

Have a look at mine in my signature. I really had to use 2. One with the american values
and then another converted with the Canadian ones (helpful for the vet).
Formulas will do the conversions for you.

Let me know if you would like to work the way I did and I can help you out.
You can send me a PM (private message) and we can coordinate a chat if you would like, my pleasure.
Max is off insulin since April so we do not have regular condos.